Shahab Riad, Phillips David E, Jones Andrew S
Head and Neck Oncology Group, Faculty of Medicine, University of Liverpool, UK.
J Laryngol Otol. 2004 Jul;118(7):500-7. doi: 10.1258/0022215041615155.
Prostaglandins and leukotrienes are implicated in conditions of both the upper and lower airways. In the former they are deranged in nasal polyposis, intrinsic rhinitis and allergic rhinitis while in the latter they are involved in the pathogenesis of asthma. The aim of the present study was to measure mucosal eicosanoid levels in the three types of rhinitis and compare with controls. In addition, the effect of topical steroids on eicosanoid levels in rhinitis was examined. The levels of prostaglandins E(2) (PGE(2)) and D(2) (PGD(2)) and of leukotrienes E(4) (LTE(4)) and B(4) (LTB(4)) were measured in nasal biopsies from the inferior turbinates of patients suffering from perennial rhinitis and a control group. Rhinitis patients were classified into three categories: perennial allergic rhinitis (PAR), non-allergic rhinitis with eosinophilia (NARES) and noneosinophilic non-allergic rhinitis (NENAR) on the basis of symptoms, secretion eosinophilia, nasal resistance and allergy testing. Patients with rhinitis were randomized into two groups. One received fluticasone propionate nasal spray (FPANS) and the other a placebo (PNS) over a period of six weeks prior to the biopsies. One hundred and one patients with PAR, NARES or NENAR were recruited sequentially and the control group consisted of 21 patients with no evidence of rhinitis but with nasal obstruction due to septal deviation. Untreated rhinitics had significantly lower levels of PGE(2), PGD(2) and LTE(4) than non-rhinitic controls. Six-weeks' treatment with FPANS significantly increased the levels of those eicosanoids in patients with PAR and NARES but they were still significantly below normal. Levels of LTB(4) in all three rhinitis groups were not significantly different from controls and treatment with topical steroids had no effect. Their findings are contrary to current thinking that increased levels of eicosanoids, in particular cysteinyl-leukotrienes, play an important role in the pathogenesis of chronic, non-infective upper airway inflammation.
前列腺素和白三烯与上、下呼吸道疾病均有关联。在前者中，它们在鼻息肉病、内源性鼻炎和变应性鼻炎中紊乱，而在后者中，它们参与哮喘的发病机制。本研究的目的是测量三种鼻炎类型的黏膜类二十烷酸水平，并与对照组进行比较。此外，还研究了局部用类固醇对鼻炎中类二十烷酸水平的影响。在患有常年性鼻炎的患者下鼻甲鼻活检组织以及对照组中，测量了前列腺素E₂（PGE₂）、前列腺素D₂（PGD₂）、白三烯E₄（LTE₄）和白三烯B₄（LTB₄）的水平。根据症状、分泌物嗜酸性粒细胞增多、鼻阻力和过敏试验，鼻炎患者被分为三类：常年性变应性鼻炎（PAR）、嗜酸性粒细胞增多性非变应性鼻炎（NARES）和非嗜酸性粒细胞性非变应性鼻炎（NENAR）。鼻炎患者被随机分为两组。一组在活检前六周接受丙酸氟替卡松鼻喷雾剂（FPANS），另一组接受安慰剂（PNS）。依次招募了101例PAR、NARES或NENAR患者，对照组由21例无鼻炎证据但因鼻中隔偏曲导致鼻塞的患者组成。未经治疗的鼻炎患者的PGE₂、PGD₂和LTE₄水平显著低于非鼻炎对照组。FPANS治疗六周后，PAR和NARES患者的这些类二十烷酸水平显著升高，但仍显著低于正常水平。所有三个鼻炎组的LTB₄水平与对照组无显著差异，局部用类固醇治疗无效。他们的研究结果与目前认为类二十烷酸水平升高，尤其是半胱氨酰白三烯在慢性非感染性上呼吸道炎症发病机制中起重要作用的观点相反。
